Working with Nigerian Policymakers to Share Lessons on National Health Insurance

Health Systems 20/20 features Health economist Dr. Hong Wang and the Joint Learning Network's workshop "Expanding Coverage to the Informal Sector" held in Mombasa, Kenya in June 2011.

Health economist Dr. Hong Wang did not come to the “Expanding Coverage to the Informal Sector” workshop to share a chapter from his book—he came to empower others. National policymakers from 13 developing countries took center stage at the four-day workshop hosted by the Joint Learning Network for Universal Health Coverage (JLN), sharing accomplishments and challenges to providing health coverage to poor and informal sector populations.

During the event in Mombasa, Kenya this June, Health Systems 20/20’s Dr. Wang assisted a team from Nigeria comprised of Ministry of Health, Ministry of Finance, and National Health Insurance Scheme staff; and he served as a resource person to the overall workshop.

The Nigeria team presented successes and lessons learned from their national health insurance scheme (NHIS), which provides free primary services to children under five and free primary and secondary services to pregnant women. In addition to expanding coverage, the NHIS is a means for tackling the Millennium Development Goals for maternal and child health. The insurance scheme aimed to cover 1.1 million pregnant women and children under five in 12 provinces. By March 2011, the team had exceeded their goal, reaching 1.5 million people. An independent study by USAID reported that the project “produced significant benefits to its target population and the communities in which they live” and estimated that the NHIS received a 640 percent return on investment. Other achievements of the NHIS project include improved facility infrastructure and quality of services delivery, a strengthened referral system, and elimination of financial burden for enrollees to access MCH services.

Dr. Wang introduced the Nigeria country case to this workshop and facilitated a panel discussion where the NHIS team presented meaningful successes and setbacks. “It's often by responding to challenges that we develop innovative solutions,” said Dr. Wang. One difficulty the Nigeria team faced was having insufficient information for project planning and monitoring and evaluation. The team overcame this by carrying out a baseline survey, which is currently being analyzed to better understand regional health care needs.

Health Systems 20/20’s participation in the 2011 JLN workshop grew out of a 2009 regional health insurance workshop in Ghana designed and carried out in collaboration with WHO, the World Bank, and other partners. At the workshop, Health Systems 20/20 identified Nigeria as one of several countries that could benefit from follow-up technical engagement and knowledge sharing opportunities.

Although many questions about how to provide health insurance to the poor remain, the JLN allowed leaders from Bangladesh, Cambodia, Ghana, India, Indonesia, Kenya, Malaysia, Mali, Nigeria, the Philippines, Rwanda, and Vietnam to share successes and challenges, and build a network of peers striving to improve access to care.

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